I have given birth to three children. My last child was delivered without an episiotomy. I have noticed a change in the size of my vagina as a result of this. I am too embarrassed to have sex because I feel too loose. Is this common with multiple childbirths? I am too ashamed to ask anyone this. Please let me know if there is something that can be done to repair my womanhood.

Dear Reader,

It can be embarrassing to discuss these issues, but many women have experienced the exact same concerns, particularly after having several children. Your medical practitioner won't be surprised to hear that you've got these concerns, so it makes sense to bring up your worries at your next appointment, or make a special appointment to talk things over before you are examined.

You say you are embarrassed to have sex because you feel too loose. Is this something that your partner told you, or did you come to this conclusion by squeezing, or trying to squeeze, your fingers if you put them inside of you, using the muscles of your vaginal opening? Maybe inserting a tampon clued you in? Childbirth can bring changes in a person's body and sexual response. Every now and then, accommodations, such as trying various positions, having different expectations, or using lube, need to be made. Sometimes medical assistance can be helpful. Talk with your partner, although it may be embarrassing or hard to do, about what you both notice and/or worry about. These unexpected changes are part of a person's life and it's normal to accommodate them over a person's life span or a long-term relationship.

Are you having any trouble holding your urine? Often women who have the sensation that their vagina is stretched also notice that they leak urine, especially when they laugh, sneeze, or cough.

Kegel exercises strengthen pelvic floor muscles, the muscles that stretch during childbirth. They help improve sexual pleasure (more intense orgasms) by making the muscles stronger and more elastic, and they can improve bladder tone so that you don't leak urine. They won't, however, actually make your vagina smaller, but they can make the opening tighter.

Here's how to do Kegel exercises:

When you're peeing, clench (without your hands) your muscles to stop the flow of urine for about four seconds. Then release those same muscles to let the urine flow again. These are your pelvic floor muscles; these are the muscles you'll be exercising when you do Kegels.

If you want to check and make sure that you're using the right muscles, put a finger or two into your vagina. Tighten the muscles. If you can feel your fingers being squeezed (even just a little), then you've located the right muscles.

About five to ten times a day, repeat the Kegels ten times per session.

It can take up to 8 to 10 weeks to notice improvement, and there will most certainly be improvement. Like any kind of weight lifting or muscle building exercises, Kegels take time to make a difference! (Adding a vaginal barbell to your regular Kegel exercise routine can help. They are available at specialty stores that carry sex toys or sexual enhancement items.)

If you do Kegel exercises enthusiastically and regularly, and notice no change at all, ask your health care provider about other methods to strengthen your pelvic floor muscles, including:

Vaginal cones
These objects are weighted, tampon-sized devices that a woman puts into her vagina and holds there. A set of cones increases gradually in weight. One starts with the lightest cone, inserts it into the vagina, and squeezes the muscles to hold it in place. This is done twice a day, for about fifteen minutes per session, while going about one's usual activities. When a woman is successful at keeping the cone in place, she can move on to the next heavier cone, working her way up to the heaviest.

Electrical stimulation (called NMES or Neuromuscular Electrical Stimulation)
This method uses a probe in the vagina to stimulate the muscles of the pelvic floor with an electric current, which causes the muscles to contract and relax. Treatments are performed every one to four days and last about 20 minutes per session. Depending on the situation, one might do these treatments for a few weeks, or longer. Some health care providers perform these sessions in their offices; others prescribe home units for their patients.

NeocontrolTM
This is a special chair that uses magnetic fields to stimulate the muscles of the pelvic floor. These treatments are usually administered by a technician or nurse in a urologist's office in 20 to 30 minute sessions, twice a week, for about eight weeks.

If you have severe problems due to vaginal stretching, some health care providers will recommend surgery; this is usually a last resort. Laser procedures and more complicated ones to re-position your bladder are available. You and your provider will figure out what makes sense for you.

There is nothing to be ashamed about — this is a common experience for women, as well as information you need to know.

June 25, 2012

April 10, 2012

509740

After my 4th child, I felt so loose that it was extremely embarrasing; however, after talking with my primary healthcare provider much has changed. Two months of Kegel exercises, along with the cone...

After my 4th child, I felt so loose that it was extremely embarrasing; however, after talking with my primary healthcare provider much has changed. Two months of Kegel exercises, along with the cone weight training exercises mentioned above, I have gained back most of the muscle mass in my pelvic floor that I had lost. What a difference! You just have to remember your body has been through some of the toughest events after childbirth you will have to be patient. Remember, it will get much better.